Starfish Fitness Enrollment Form
Learn 2 Swim , Squad Swimmers , Triathletes
What are you signing up for?
Family Name
Your answer
Name Person 1/
Your answer
Date of Birth
MM
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DD
/
YYYY
Person 2
Your answer
Date of Birth
MM
/
DD
/
YYYY
Person 3
Your answer
Date of Birth
MM
/
DD
/
YYYY
Person 4
Your answer
Date of Birth
MM
/
DD
/
YYYY
Name of parent or guardian
Your answer
Street Address
Your answer
Suburb
Your answer
Postcode
Your answer
Phone
Your answer
Mobile
Your answer
Email Address
Your answer
If person is not available in the event of an emergency, Notify
(Please label name and contact number)
Your answer
Do you or anyone included in this form have the following?
If you ticked any of the boxes above please explain here
Your answer
I give permission for Starfish Fitness, subject to the limitation noted herein. In case of emergency, I understand every effort will be made to contact me (if participant is an adult, my spouse or next of kin). in the event I can not be reached, I hereby give my permission to the licensed health-care practitioner selected by Starfish Fitness to secure proper treatment, including hospitalization, anaesthesia, surgery, or injections of medication for my child ( or myself, if participant is an adult). I realise the risks involved in participating in any activity which may included but not limmited to stustained injuries, even death and therefore will not hold Starfish Fitness or it's coaches liable for damages which occurred during activities contacted by or on behalf of Starfish Fitness. Learn to swim make up policy is as followed; you must inform us prior to the missed lesson and then you will have seven (7) days to book a make up. I consent to times and photo's being placed and published on www.starfishfitness.com and Starfish Fitness Facebook page. I agree to the terms stated,
Please digitally sign your FULL name here
Your answer
Did someone refer you to us? if yes who?
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